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Texas rates for HCPCS J0470

Injection, dimercaprol, per 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.34 / $57.89 / $123.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.34 / $52.63 / $71.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.91 / $53.91 / $53.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.55 / $54.55 / $54.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.55 / $54.55 / $54.55
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $299.05 / $299.05
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.74 / $52.63 / $75.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.14 / $48.14 / $48.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $54.55 / $75.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.55 / $54.55 / $54.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.42 / $56.42 / $56.42
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.42 / $56.42 / $76.17